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Monday, April 15, 2019

Classical Quotes for Critical Care

Suriyakanthi Amarasekara had recently been invited as the Chief Guest to make a presentation to the Clinical Society of Sri Jayawardenepura Hospital. What follows is a gist of her talk. 

When I received the gracious invitation to be the chief guest at the Scientific Sessions of the Clinical Society, I had to choose a topic of my address. After much thought I decided that rather than talk to you on a ponderous scientific theme, I would share with you some of my collection of quotes concerning life and critical care. I may add that from my early teens I got into the habit of jotting down anything that touched my heart so what is presented to you in the next few minutes is picked from a collection that has taken me almost a half century to compile.

All of us present here are engaged in working. So I would like to start with a quote by Khaleel Gibran from his masterpiece “The Prophet”

“A plough man said speak to us of work.
And he answered saying
You work that you may keep pace with the earth and the soul of the earth
For to be idle is to become a stranger unto the seasons,
And to step out of life’s procession that marches in majesty and proud submission towards the infinite
When you work you are a flute through whose heart the whispering of the hours turn to music.
Which of you would be a reed dumb and silent, when all else sings together in unison ?
You have been told that life is darkness.
And in your weariness you echo what was said by the lonely.
And I say that life is indeed darkness save when there is an urge,
And all urge is blind save when there is knowledge,
And all knowledge is vain save when there is work,
And all work is empty save when there is love.
And when you work with love, you bind yourself to yourself,
And to one another and to God

I firmly believe that no one working in critical care of for that matter caring for the sick in any location can be truly successful and happy unless he has a special care and concern for the welfare of his patients. We need to treat or patients with compassion and we need to work with love.
I think that St Paul’s epistle to the Corinthians captures the type of love we should have when he wrote:

“though I speak with the tongues of men and angels, and have not love, I am becoming as a resounding gong, or a clanging cymbal.
And though I bestow all my goods to feed the poor, and though I give my body to be burned, and have no love I am nothing.
Love is patient, love is kind.
Love does not envy and does not boast
Love is not proud, it is not rude it is not self seeking
Love is not easily angered, it keeps no records wrong
Love does not delight in evil but rejoices with the truth
Love always protects, always trusts, always hopes and always preserves
Love never fails”
I remember being told many years ago, to replace the word love with “I” .
So to paraphrase
I am patient,  I am kind.
I do not envy and do not boast
I am not proud, I am not rude I am not self seeking
I am not easily angered, I keep no records wrong
I do not delight in evil but rejoice with the truth

This shows us how far short we fall from the expected ideal
Every patient is important, and every encounter with that patient and his family is important. Things that we may sometimes consider trivial, and therefore overlook, may have tremendous significance, especially in view of the complexity of multiple medical problems that we are faced with.

As John Donne said,

“No man is an island entire of itself,
Every man is a piece of the continent, a part of the main…..
Any man’s death diminishes me because I am involved with mankind
and therefore never send to know for whom the bell tolls,
it tolls for thee”.

Very few people work harder than ICU personnel, but not infrequently, it does not really seem to change things. All our skill, wisdom and efforts may seem to be of no avail, not only with patient care, but also academically.

“I returned and saw under the sun
That the race is not to the swift
Nor the battle to the strong
Neither yet bread to the wise
Nor yet riches to men of understanding
Nor yet favour to men of skill
But time and chance happens to them all”
Ecclesiastics 9 : 11 – 12

Sometimes we feel so let down and disappointed by the circumstances we are faced with, that we wish we could transform the situation and remake the world

“Ah love could you and I with fate conspire
To grasp this story scheme of things entire
Would we not shatter it to bits and then
Remold it nearer the Hearts Desire”.
The Rubaiyat of Omar Khayyam Stanza 99
Often our efforts seem futile and there seems to be nothing we can do about what is happening around us
“the moving finger writes and having writ
Moves on: not all your piety or wit
Shall lure it back to cancel half a line
Nor all your tears wash out a word of it”
The Rubaiyat of Omar Khayyam Stanza 71

But we should not be discouraged. In life, in medicine there are few “quick fix” situations. But eventually the impact of our efforts begin to show.
‘The smallest effort is not lost
Each wavelet on the ocean tossed
Aids in the ebb tide or the flow
Each raindrop makes some flower glow
Each struggle lessens human woe’      Charles Mac Kay

For an ICU or that matter any Unit or Ward to function optimally, everyone on the team has to do his job well no matter how menial or small the task is.

“We can’t all be captains, we’ve got to be crew
There’s something for all of us here
There’s big work to do, and there’s lesser to do,
And the task you must do is near
If you can’t be a pine on the top of a hill
Be a scrub in the valley – but be
Be the neat little scrub by the side of the rill
Be a bush if you can’ t be a tree
If you can’t be a highway then just be a trail
If you can’t be the sun be a star
It isn’t by the size that you win or fail
Be the best of whatever you are!”
Douglas Malloch

We must also recognize that we can never stop trying to learn. Acquiring medical knowledge is like rowing up stream against a strong current. You have to work very hard to make any headway at all, but if you slacken your efforts you are rapidly swept down stream. I recall that I never felt confident about my medical knowledge as I did when I was a 3rd year Medical Student

“A little learning is a dangerous thing
Drink deep, or taste not the Pierian spring
There shallow draughts intoxicated the brain
And drinking largely sobers us again”
Be not the first by whom the new are tried
Nor yet the last to lay old aside
An essay on Criticism Alexander Pope

A sense of humour is something that we need to cultivate if we are to keep our sanity in this stressful world of ours.
If you see the funny side, you’ll stroll along the sunny side
While other folks are walking in the shade
Things will never harass you, embitter or embarrass you
A sense of humour is the finest aid
To wisdom and philosophy, in trouble and adversity
It brings you smiling through the stress and strife
So cultivate the power to see, the little touch of comedy
Behind the trials and tragedies of life

We often do not appreciate the role played by the nurses in the care of critically ill patients. The 3rd stanza of William Wordsworth’s poem “She was a phantom of delight” captures the description of a perfect ICU nurse

“Endurance, foresight, strength and skill
A perfect woman, nobly planned
To warm to comfort and command
And yet a spirit still and bright
With something of angelic light”
And again
Oh woman in our hour of ease,
Uncertain, coy and hard to please
Uncertain as the shade
By the quivering aspen made
But when pain and anguish wring the brow,
A ministering angel thou”

I recall an incident when I was about 14 years old, I was running a very high temperature and having a blistering headache. My mother gently placed a cloth soaked in iced Eu de cologne on my forehead. It felt so soothing that I caught her hand and quote the above poem to her. My mother’s response was to pop a thermometer in my mouth – she thought I was delirious!
Eventually no matter how hard we work we need to go to a very special place we call home. At home at the end of the day we may finally be able to relax with some peace and quiet

Longfellow captures a sense of that relaxation that might come at the end of the day in his poem The day is done
“The day is done and the darkness
Falls from the wings of night
As a feather is wafted downward
From an eagle in his flight
And the night shall be filled with music
And the cares that infest the day
Shall fold their tents like Arabs
And as silently steal away”

As we are just  a little over 2 weeks away from the dawn of the New Year, some of you may be thinking of making new year resolutions. So I thought I would share with you a poem I wrote for the SLMA Newsletter in January 2006:

This I would like to be, braver and bolder, just a bit wiser, because I am older
Just a bit kinder to those I may meet, just a bit braver taking defeat
This for the New Year, my wish and my plea,
May this New Year make a good doctor of me
This I would like to be, just a bit finer, more of a smiler and less of a whiner
Just a bit quicker to stretch out my hand, helping another, who’s struggling to stand
This is my wish for the New Year to be
May this New Year make a good doctor of me
This I would like to be, just a bit truer, less of a wisher and more of the doer
Caring, compassionate, more willing to give, living and helping me patients to live
This for the New Year, my wish and my plea,
May this New Year make a good doctor of me

Finally I would like to end with the words of Henry Wadsworth Longfellow from A Psalm of Life
“Lives of great men all remind us
We can make our lives sublime
And departing leave behind us
Footprints on the sands of time
Footprint that perhaps another
Sailing o’er life’s solemn main
A forlorn and a shipwrecked brother
Seeing, shall take heart again
Let us then be up and doing
With a heart for any fate
Still achieving, still pursuing
Learn to labour and to wait”

Ladies and Gentleman I thank you for your attention.

Wednesday, April 10, 2019

Creative Spot Quiz

By Indra Anandasabapathy 

Guess what's going on inside the building. The clues are there for the viewer to figure out

Sunday, April 7, 2019

Prof. Lamabadusuriya marks 50 years as a medical academic

From The Island newspaper of Sunday 7 April, 2019.

April 6, 2019, 6:43 pm

S.P. Lamabadusuriya

Prof. Sanath. P. Lamabadusuriya who joined the Faculty of Medicine Colombo as a lecturer in Paediatrics on April 1, 1969, this month marked his 50th year as a medical academic. He has worked in this field both here and abroad and in 1992 was conferred an MBE by Queen Elizabeth.

Afetr taking his MBBS degree, he went abroad in 1972 on a Colombo Plan scholarship for post graduate training and returned three years later with a Ph.D. (London), MRCP (UK) and DCH (London). He was trained at the Hospital for Sick Children Great Ormond Street, London and at the Institute of Child Health, London.

Prof. Lamabadusuriya I was the first Sri Lankan clinician to obtain a research degree which he achieved after two years and three months of research. Later he worked at the Faculty of Medicine of the Colombo University as a Senior Lecturer until he went to the Faculty of Medicine Ruhuna as the Foundation Professor of Paediatrics.

In 1980 he returned to Colombo when the Chair in Paediatrics fell vacant in 1991. He retired in 2008 and now serves as an Emeritus Professor of the Colombo University.

He was the Dean of the Colombo Medical Faculty from 2002 to 2005 and since April 2015, been working as a Visiting Senior Professor in the Faculty of Medicine in the University of Rajarata.

Over a year ago he was invited to be the consultant to establish a Medical Faculty in the Sabaragamuwa University to which 70 students were admitted in January this year. This faculty is based in Ratnapura.

During sabbatical leave, he worked as a Locum Consultant in Paediatrics at the Pilgrims Hospital in Boston, Lincolnshire, England in 1979. From 1987 to 1988, he worked as a Professor in Paediatric Gastroenterology at the King Faisal University in  Dammam,,Saudi Arabia. From 1996 to 1998 he worked as a locum Consultant Paediatrician in Worthing, West Sussex. England.

He was awarded an MBE in 1992 by Queen Elizabeth in recognition for his contribution to the Sri Lanka Cleft Lip and Palate project – probably the first Lankan domiciled here to be so honored..

This project was instrumental in setting up a diploma course for the training of Speech Therapists in the University of Kelaniya, with a donation of 200,000 pounds sterling. Prior to that there was only one speech therapist in Sri Lanka and she was in the private sector. At present there are over 80 speech therapists working in Sri Lanka.


Sent by Indra Anandasabapathy

The following series of mail box photographs shows this work which has a humorous side. This series excludes
pictures 1& 2 , which are the old fashioned boxes. The rest are creations of a company whose work is 
gathering momentum in this town. 

 Among them  - a lady with a surf board in a beach town

                       - a flamingo

                       -  mail box in front of a cafe


Picture 1

Picture 2

In front of a physician's office (viewers can guess the speciality!)

Wednesday, April 3, 2019

News from Sanath Lamabadusuriya

Sanath has just returned from his recent tour of Panama where he attended the International Congress of Paediatrics. He made use of the opportunity to tour Cuba, a country about which we have heard so much.

An interesting observation he made on this tour was that Panama City is like any other western capital with many skyscrapers but that Havana in Cuba does not have a single skyscraper. He goes on to say that Havana is full of American classic cars, Buicks, Cadillacs, Dodges, Chryslers, Chevrolets, Plymouths, Oldsmobiles, Fords etc which were manufactured in the 1950s.

Soon after his arrival in Sri Lanka, he lost no time in proceeding to Anuradhapura where he is teaching the Rajarata medical students. He had been pleasantly surprised when the students hosted a party to felicitate Sanath's 50th year in academic Paediatrics.

Saturday, March 30, 2019

Srianee and Jayaratnam in Sri Lanka

Srianee (Bunter) and Jayaratnam are in Sri Lanka right now. 
They were at our Battaramulla home today for lunch with a few other friends.

Mangala, Hemantha, Pram, Jayaratnam

Senerat, Srianee, Mangala, Hemantha, Jayaratnam (back to camera)

Srianee (Bunter), Lucky, Jayaratnam, Pram 

Pram, Senerat, Hemantha 

Friday, March 22, 2019

Sri Lankan version of Bohemian Rhapsody

I received this from Speedy.

Bohemian Rhapsody

This song became topical recently after the release of the award winning film based on the life of Freddie Mecury, the star of Queen. Bohemian Rhapsody is a foot-stomping celebration of Queen, their music and their extraordinary lead singer Freddie Mercury. Freddie defied stereotypes and shattered convention to become one of the most beloved entertainers on the planet. I think this song is one which will retain its attraction forever. It is brilliant, innovative and a work of art.

Suri sent me this YouTube clip of the Sri Lankan version and her son Sean  had a big part in it. Suri says "The vocals (except the single female lines) are by my son Sean (who you have met) harmonising with his own voice. The lines " dosthara wanna be aney.... " is single by another chap, not Sean and also a few lines further on. But  the main Vocals and harmony  are all Sean's

I am sure our readers would love to view it and hats off the xx for his superb performance.